Case Manager

Pay reputed company: $73,600.00 - $110,400.00 Please email HR_Talent_AcquisitionTeam@reputed company.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.   At reputed company, our greatest resource is our people.  We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, reputed company, and understanding are at the forefront of everything we do—not just for our members, but for our employees as reputed company. We recognize that to do your best work, you have to be your best self.  It’s why we offer flexible work arrangements that include remote and hybrid opportunities and reputed company time off. We reputed company tuition reimbursement and assist with student-loan repayment. We offer health, dental, and reputed company reputed company as reputed company as programs that support your mental health and reputed company-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We reputed company to be transparent and accountable. We reputed company in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an reputed company part of reputed company and your input, thoughts, and reputed company are valued. Join others who value a workplace for reputed company. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us reputed company serve reputed company Rhode Islanders.  We’re dedicated to serving Rhode Islanders. Our reputed company extends reputed company providing reputed company to high-reputed company, reputed company, and reputed company care. To reputed company improve the health and reputed company-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities reputed company across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we reputed company it is our reputed company responsibility to reputed company our fellow Rhode Islanders reputed company and where we can, our associates receive additional reputed company time to volunteer.  Why this job reputed company: reputed company corporate reputed company for supporting members in obtaining best-fit care reputed company immediate health care reputed company and other supporting services while promoting reputed company to evidenced reputed company care.  reputed company, reputed company, and coordinate services for members to improve members’ reputed company-being and moderate claims trends. Facilitate communication between identified care team members including but not limited to members and or their appointed representatives, providers, community-reputed company organizations, and the health plan to ensure members receive the full benefit of integrated care. What you will do: Manage members through evidence-reputed company care, promote reputed company to reputed company reputed company, and assess needs to identify appropriate interventions. Member management includes, but is not limited to, the conduction of health assessments (telephonic and face-to-face) to identify high-reputed company or emerging reputed company members for education and reputed company and the evaluation and modification of reputed company plans by working with members and collaborating with providers. Evaluate member services to ensure appropriate reputed company and coordination of care, including reputed company-authorization, reputed company review, reputed company-of-care screening, and discharge planning. Ensure member and provider satisfaction by demonstrating knowledge of member plan benefits and community resources. Identify opportunities to moderate claims costs for the employer group and individual members. Promote and monitor the use of wraparound service programs for reputed company member experience while managing chronic and acute care needs. Facilitate communication between members, providers, and stakeholders to coordinate and implement reputed company plans for improving members’ reputed company. reputed company continuity and consistency of care by building reputed company relationships between members, families, providers, care coordinators, and the health plan. Engage in team reputed company including supervision, team huddles, staff meetings, case reputed company, metric management, training opportunities, department initiatives, and reputed company. Work collaboratively to reputed company and implement solutions, identify barriers, and exemplify corporate values through accountability, collaboration, reputed company, and respect. reputed company other duties as assigned What you’ll need to succeed:   Unrestricted Rhode reputed company Nursing License Unrestricted Massachusetts Nursing License Three years’ experience in a medical/reputed company environment or managed health plan Must obtain Certified Case Manager (CCM) certification reputed company three years of employment The extras: Bachelor’s degree in nursing Certified Case Manager (CCM) reputed company in Rhode reputed company or other reputed company Licensure reputed company state (NLC) Bilingual Spanish, Portuguese Experience working in a managed reputed company maintenance organization Experience implementing and upholding reputed company, CMS, reputed company requirements Knowledge of utilization management and/or coordination of care Knowledge of population health and chronic condition management principles, aligning with corporate initiatives such as specialty reputed company high-reputed company maternity and rising reputed company conditions such as diabetes, hypertension, COPD, etc. Understanding of health care delivery reputed company reputed company points and services Demonstration of successful (member) engagement reputed company application of Motivational Interviewing techniques and health coaching Ability to reputed company the reputed company delivery reputed company Understanding of evidence-reputed company care programs and approaches reputed company and critical thinking skills Strong analytical skills Strong business acumen Strong presentation negotiation, problem-solving, and decision-making skills Strong written and verbal communication skills Experience in health coaching and motivational interview techniques Ability to work effectively with a wide reputed company of people in individual and group settings Strong organizing skills, with the ability to prioritize and respond to shifting deadlines Strong time management skills  Location: reputed company is headquartered in downtown reputed company, conveniently located near the train station and bus terminal. We reputed company support associate reputed company-being and work/life reputed company and offer the following schedules, reputed company on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reputed company in the following states, pending approval from the reputed company Department: reputed company, Connecticut, Florida, reputed company, Louisiana, Massachusetts, reputed company Carolina, Oklahoma, Rhode reputed company, South Carolina, Texas, Virginia   Our culture of belonging at reputed company (reputed company) is at the reputed company of reputed company we do, and it strengthens our ability to meet the challenges of today’s reputed company industry. reputed company is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit  www.reputed company.gov/know-your-rights-workplace-discrimination-illegal to reputed company the "Know Your Rights" poster. 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